Stillbirth

Stillbirth is when a baby dies in the womb after 24 or more weeks’ pregnancy and is born. Stillbirths are common; around 1 in 200 births in the UK are stillbirths. If a baby dies in the womb and the mother’s health is at risk, the birth might need to happen urgently. More commonly, women have time to prepare and consider their preferences for the birth and aftercare.

Having a stillbirth can be extremely distressing for the parents and others in the family. Grieving for the loss of a baby is a very personal and difficult experience. You may find a counsellor helpful, especially if you’re having difficulty coping after a few months.

If you have had a stillbirth, you may find the latter half of this page (from ‘Coping with your emotions’) most helpful.

Symptoms that your baby is at risk or has died

Symptoms that suggest that your baby might be at risk of dying in the womb, or might have died are:

The amount that your baby is moving has significantly decreased, or the pattern has changed (taking into account the usual quiet times in your baby’s movements).

You’re leaking fluid from your vagina or have unusual discharge. This might be a signal that you have an infection or that your waters have broken early.

You have vaginal bleeding, which may indicate a problem with the placenta.

You have severe tummy pain or contractions, which may indicate early labour or a problem with the placenta.

If you have any of these symptoms, contact your labour ward, midwife or GP right away. It may turn out that there’s nothing to worry about, but it’s best to be cautious.

Diagnosis that your baby has died

If your baby has died, you might have noticed one of the above symptoms. However, the death might be discovered in a routine check-up.

If your obstetrician (a doctor specialising in pregnancy and childbirth) thinks your baby may have died, they will ask to perform an ultrasound. You may well have had ultrasounds earlier in your pregnancy. Ultrasounds use sound waves to produce an image of your womb and baby.

Checking for a heartbeat is not used on its own to diagnose the death of a baby in the womb. Sometimes a heartbeat cannot be heard even though the baby is alive.

If your baby has died, your obstetrician will explain this and help you make choices about what happens next. Finding out that your baby has died will be shocking and unexpected. You may find it difficult to take on board all the information you’re given. You may need more time to think or want to go home for a while. Your obstetrician will understand – ask questions and share your preferences and concerns.

Causes of stillbirth

For most parents, it’s important to know why their baby died. Unfortunately, a reason can be found in only about half of all stillbirths. Most often, the baby’s death is caused by a problem with the placenta, stopping the baby getting the oxygen and nutrients it needs. There are many other reasons a stillbirth can happen though. These include:

the placenta coming away from the womb wall before birth (this is called placental abruption)

pre-eclampsia, which causes high blood pressure and protein in your urine

a medical condition the mother has, such as diabetes, high blood pressure or problems with blood clotting

the umbilical cord being trapped or coming out of the cervix (a prolapse)

Care during and after stillbirth

If your baby has died in the womb, you’ll need to give birth to him or her. It can be a shock for parents to realise that this needs to happen – your obstetrician will explain the process and options to you. You’ll be cared for sensitively by your care team, which can include an obstetrician, midwife, nurse, and anaesthetist.

You’ll need to make some important decisions, including about:

when, where and how to give birth to your baby

what investigations you wish to take place to look into the cause of your baby’s death

having a memorial service and funeral for the baby, and registering the death

The choices that people make vary very much from person to person. Your preferences may depend on many factors, such as your personal beliefs, health and religion. You may find some decisions harder to make than others. Talking to your partner, family, friends, nurse, obstetrician and other professionals may help.

Care during the birth

Legally, the mother has the final say in choices regarding the labour and birth, but you don’t need to make decisions alone. If you would like help and support, your care team can make recommendations for the type of birth, the medical facilities needed and the timing. Your obstetrician will advise you to give birth in a place that has emergency care available. You may want to ask for a private area away from other mothers and babies. Some hospitals have facilities for your partner or a companion to stay with you too.

Unless there is an immediate risk to your health, the birth does not need to happen rightaway. If you want to, you can delay the process (eg for a few days) until you feel more prepared. If you decide to go home, make sure you have a 24-hour contact number for information and support.

Some women choose to wait for the birth to begin naturally. With this approach, five out of six women go into labour within three weeks of their baby’s death being diagnosed. If you do this, you’ll need to have a blood test twice a week to check your health. It’s best not to delay too long though, as this can lead to complications and may worsen any anxiety you have. Waiting can also lead to a decline in the baby’s appearance, and can make it harder to work out the cause of death.

Alternatively, you may choose or need to have your labour induced (started artificially) using medicines. Most women who have labour induced give birth within 24 hours.

Most women are advised to give birth naturally (vaginally) rather than to have a caesarean, because there are fewer health risks and you’ll recover sooner. Your care team will make the necessary arrangements and will do their best to make you comfortable and minimise your distress and pain.

Labour is painful, and you’re likely to want some pain relief. A midwife or anaesthetist specialising in births will explain your options. These include medications or regional anaesthesia. The medicines could be tablets, Entonox (usually called ‘gas and air’) or injections (diamorphine). Once labour is underway, you may want a stronger pain relief, in which case you may have an epidural (an injection of anaesthetic near the spine). This is safer than a general anaesthetic and women tend to recover quicker. If you have a caesarean an epidural is usually required. Another option is patient-controlled pain relief, where you press a button to get a small dose of painkiller through a drip.

Once your baby is born, be prepared that the room may feel unbearably quiet. You can see, hold and spend time with your baby after the birth. Your care team can make any preparations you need, and can explain how your baby looks. You may feel frightened or unsure about seeing the baby. Don’t feel pressured to see the baby if you don’t want to. Equally, it’s an extremely precious moment for some parents. Do what is right for you.

Your care team can help with mementos of your baby, such as photos, a hand or footprint or lock of hair. It’s your choice whether or not you have these. They can be kept securely at the hospital for you if you’re unsure. You may wish to take other keepsakes to the hospital, such as matching blankets or toys, to be kept with you and the baby.

Care immediately after the birth

After the birth, you’ll receive any additional medical treatment and support you need. You will usually be offered visits from the community midwife for the first 10 days, who will offer emotional support and check your physical recovery. You may be offered antibiotics if your obstetrician thinks you have an infection or are at particular risk.

If you need to stay in hospital, there might be an option to stay in a different area than the maternity ward, if you prefer. As soon as you’re well enough, you can go home.

Women who have had a stillbirth still produce breast milk. This can be painful and a difficult reminder of the loss of your baby. You can have medication to stop your breast milk. Most women find that a medication called a dopamine agonist (eg cabergoline) works well with few side-effects. Other options include using a support bra, ice pack or painkillers, but you’re likely to have some breast pain with these approaches.

You’ll also have vaginal bleeding after the birth for a few weeks.

It’s best not to get pregnant again until you feel physically and mentally ready, so your care team may give you advice on contraception. They’ll also let other healthcare professionals involved in your pregnancy and antenatal care know what has happened.

Making arrangements after the birth

If you’d like to name your baby, it is important you choose a name before the death is registered. The name cannot be changed or entered afterwards.

You and your partner will need to decide on plans for a burial, cremation and remembrance for your baby and arrange this with others’ help. Your care team can provide information to help you decide. If you want to hold the funeral within 24 or 48 hours of your baby’s death for religious reasons, let your care team know right away. If your baby is having a post-mortem, arrangements will need to be made swiftly. It may be that a full post-mortem cannot be performed in the timeframe.

Investigations into the cause

Most people want to know the reason for the loss of their baby. However, in almost half of all stillbirths a cause can’t be found. This can be difficult to cope with. Most often, the baby’s death is caused by a problem with the placenta, such as it coming away from the womb. There are many other reasons a stillbirth can happen though, including congenital problems with the baby (problems with the baby’s development in the womb), an infection or a medical condition the mother has.

Your obstetrician will recommend that tests are done to check your health and to try to work out why your baby died. This is important to check whether you need any additional medical treatment. These tests can also help to work out if you’re at risk of having another stillbirth, and how you may be able to reduce this risk.

Assessments that you’ll be offered include a physical examination, blood tests, urine tests, and vaginal and cervical swabs. If your blood type is rhesus D negative, you might be offered a test to check whether there has been a transfer of your baby’s blood into your circulation. This can make you produce antibodies that attack the baby’s blood, causing the baby to develop anaemia (low numbers of red blood cells). If this happened during your pregnancy, it could explain why your baby died. Unfortunately if this transfer of blood has happened, you are at risk of the same problem occurring during another pregnancy. If you get pregnant again, your care team will keep a close eye on this. If your blood type is rhesus D negative but this transfer of blood hasn’t happened, there are treatments that can stop this happening in the future.

Assessment of the baby usually includes a physical exam and taking blood samples and swabs. Sometimes imaging, such as an X-ray, is performed too. The placenta, umbilical cord and membranes will be checked too.

You can choose whether or not to give your permission for genetic testing and a post-mortem (autopsy) of your baby. These tests often help to confirm why your baby died. A post-mortem can also help to plan any special care you may need for future pregnancies. Not everyone wants their baby to have a post-mortem or genetic testing. You do not have to give your consent for these tests if you don’t want to.

If you choose for your baby to have a post-mortem, your baby’s body will be treated with dignity and any arrangements to transport the body will be explained. You can specify whether you agree to a full or partial post-mortem. For example, you can choose whether or not your baby is examined internally. You can also specify that only the placenta is examined in the post-mortem if you prefer. For more information on what happens in a post-mortem, see our FAQ below.

Rarely, a coroner (or procurator fiscal in Scotland) may order a post-mortem by law – it can then happen without your permission and you won’t have choices over the type of post-mortem.

Be aware that you’ll need to wait some weeks for the results of a post-mortem, depending on the hospital and the tests performed. You should be offered an appointment to discuss the results within six to 12 weeks.

Follow-up care

You’ll be offered a follow-up appointment about six weeks after the birth. This is to check how you’re doing physically and mentally, to talk through any results the hospital has so far, and to answer your questions. This will usually be at the hospital, but depending on your local services, you may be able to have it elsewhere if you prefer. You may find it helpful to write down any questions before your appointment. This is also an opportunity to give feedback to the hospital about your previous care.

If your baby had a post-mortem, you’ll be invited to an appointment with an obstetrician after six to 12 weeks to discuss the results.

You may wish to ask about the location of any follow-up appointments. If there will be other mothers and babies in the waiting area, you might find this upsetting.

Complications of stillbirth

Your obstetrician may recommend that you give birth where emergency care is available, so you can receive urgent care if needed.

Problems that can occur after a stillbirth include infections, haemorrhage (severe bleeding) and pre-eclampsia. If there is a delay between your baby dying and you giving birth, there is a greater risk of you developing a condition where your blood’s clotting system becomes imbalanced, which can lead to blood clots or bleeding. If this happens, a haematologist (doctor specialising in blood disorders) will discuss heparin therapy to reduce your risk of blood clots.

Many people have emotional and psychological difficulties after losing a baby, which we discuss below.

Coping with your emotions

Losing a baby is a devastating event. You and your partner are likely to have a range of emotions, which may include fright, shock, profound grief and sadness. Some people feel numb, confused, angry or guilty. Your emotions may come in waves, and sometimes be hard to control or be unpredictable. In addition to these emotions, you might develop postnatal depression – treatments are available to help.

Trying to cope with the loss of a baby can also put a strain on your relationships with loved ones. Family members, including your parents or children, are likely to be strongly affected too and want to do all they can to support you. You may find it important that others recognise and accept your grief.

You and your family will be offered counselling. There will be support groups to help you too, and you may have a bereavement officer assigned to help co-ordinate the support you need. For spiritual guidance, your maternity unit can arrange for you to see an elder from a common faith or an adviser from a non-religious organisation.

Some parents find that they begin to feel more able to cope and their life returning after a few months, although the baby is not forgotten. For others, strong emotions or depression can continue or they can develop post-traumatic stress disorder. Be sure to ask for any help you need, especially if you’re struggling with day-to-day life some months later. Your hospital or GP can refer you for specialist psychological care, and treatments are available to help with post-natal depression and post-traumatic stress disorder.

Preventing stillbirth

Investigations into the cause of your baby’s death may help to identify any steps you can take to reduce your chance of having another stillbirth in the future. For this reason, it is best to wait for the results before trying for another baby.

Parents can, naturally, be very anxious about stillbirth happening again. Depending on the reason for your baby’s death, you may be at increased risk of having another stillbirth. However, most women do not have another stillbirth in the future. If no cause for the stillbirth was found, you’re unlikely to have another.

If investigations find that you have an underlying medical condition, such as diabetes, this may need to be treated or monitored carefully. Your obstetrician can explain how treatment will reduce your chance of having another stillbirth in the future, and any remaining risks. You may need additional treatment and check-ups if you become pregnant. You might also be recommended to have antenatal care with an obstetrician and to give birth in a specialist maternity unit.

If your baby was found to have a genetic disorder, there might be a risk that other babies you have in the future could also have it. The doctor at the hospital can offer advice and may refer you to a genetics specialist for further support and counselling. If you get pregnant in the future, you might be able to have tests during the pregnancy to check for the condition. You might also be able to have a special type ofin vitro fertilisation (called preimplantation genetic diagnosis) to select an embryo without the condition.

Some causes of stillbirth, such as the cord becoming trapped, are unlikely to happen again.

A stillbirth is more likely to occur when the mother or father is older, you’re expecting twins, or the mother is obese or smokes. Be aware that your risk increases as you get older – you’re more at risk of having a stillbirth if you’re over the age of about 35. If you’re obese, losing weight and keeping a healthy weight can reduce your risk. Stopping smoking can help too.

You can also take steps to reduce your risk of getting infections, such as by having the rubella (German measles) vaccination.

Frequently asked questions

It is often possible to tell whether your baby is a girl or boy rightaway. However, if your baby died a while ago, their appearance may have changed. This can make it hard to be sure of their sex. A specialist or a post-mortem will be able to confirm your baby’s sex. Genetic tests can provide an answer too. If tests can be performed rapidly, you should have an answer within two working days.

In some cases, the results of tests might not be back before you wish to register the birth. You can make a judgement yourself about your baby’s sex, or ask your care team to do this, if you wish. Some parents choose to use a nickname or name that can work for both sexes.

A post-mortem is carried out by a pathologist specialising in examining babies (a perinatal pathologist). Your baby’s body will be treated with dignity and care at all times. He or she may need to be transported to another location for the post-mortem, and will be returned afterwards.

In a complete post-mortem the pathologist:

weighs the baby

examines the outside of the body

examines the placenta, umbilical cord and membranes

opens the body to measure, weigh and examine each of baby’s internal organs

takes samples of body fluid (eg blood or urine) for testing

takes small samples of tissue to examine under the microscope

arranges for genetic testing of some tissue samples

stores some samples that could be tested in the future, if needed

takes an X-ray of your baby’s skeleton

may take other photographs or images

The pathologist will then replace the organs and repair the body. Very rarely, they might ask permission to keep an organ for a longer time to perform extra tests. A post-mortem doesn’t usually affect the baby’s face, arms, legs, hands or feet. This means that you’ll not be able to see any marks from the procedure when your baby is clothed or wrapped in a blanket. A complete post-mortem gives the parents as much information as possible to help them plan for future pregnancies if they wish.

The pathologist might recommend a partial post-mortem if the cause of death can be confirmed without all procedures or organs being examined. If there are parts of the post-mortem you don’t want your baby to have, discuss this with your care team. You can give your consent for some but not all procedures to be performed. You can also choose for your baby to have an examination of the outside of their body only.

Rarely, a coroner (or procurator fiscal in Scotland) may order a post-mortem by law – it can then happen without your permission and you won’t have choices over the type of post-mortem.

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Produced by Hannah Bridges, Freelance Health Editor, March 2017
Expert reviewer Dr Evelyn Ferguson, Consultant Obstetrician and Gynaecologist
Next review due March 2020

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